The Annals of Thoracic Surgery, Vol 35, 406-414, Copyright © 1983 by The Society of Thoracic Surgeons
The effect of prostaglandin E1 in patients undergoing clinical cardiopulmonary bypass
JJ van den Dungen, GF Karliczek, U Brenken, JN van der Heide and CR Wildevuur
The effect of prostaglandin E1 (PGE1) on protection of platelets during
cardiopulmonary bypass (CPB) was evaluated in 9 patients, who were compared
with an identical control group of 10 patients undergoing coronary artery
bypass grafting. To evaluate the hemodynamic side- effects, PGE1 (0.05
micrograms/kg/min) was infused prior to CPB, resulting in a 26% drop in
mean systemic arterial pressure. With this dose, no inhibition of the
adenosine diphosphate-induced aggregation could be measured in the
pulmonary artery sample. During CPB, the same infusion dose resulted in a
severe drop in systemic arterial pressure below 50 mm Hg in 7 of the 9
patients. In 5 of these patients, volume load and phenylephrine infusion
could not compensate for the pressure drop, and PGE1 had to be reduced to
0.02 micrograms/kg/min. Platelet aggregation was reduced significantly in
the PGE1-treated group compared with the control group, but not completely
inhibited during CPB. However, in the postbypass period no platelet
preservation was seen in the PGE1 group. In both groups, platelet number
and function were equally low. No differences were measured in blood loss
or blood transfusion requirements. Except for hypotension, no side-effects
of the PGE1 treatment were seen. It is concluded that the hypotension
caused by minimal doses of PGE1 during CPB precluded using higher doses,
which might have had a greater effect on platelet inhibition. These
hypotensive side-effects should be reduced or eliminated before PGE1 can be
expected to have the same protective effect on platelet damage that has
been demonstrated in animal experiments.
